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General NPI Number Information
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NPI Number | 1508292681
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Entity Type | Individual
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Provider Name | STACEY A MCIVOR MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 18 HIGH RISE RD
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City | DANBURY
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State | CT
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Zip | 06811-3836
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Country | US
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Telephone | 203-739-5752
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Fax |
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Provider Business Mailing Address
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Address Line | 121 CODFISH HILL RD
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City | BETHEL
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State | CT
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Zip | 06801-3203
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Country | US
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Telephone | 475-279-0347
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 003957
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License Number State | CT
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